During an assessment of Medical care (Including older people's care)
Date of assessment: 27 to 28 August 2025
Frenchay Brain Injury Rehabilitation Unit (BIRU) is operated by Active Neuro Limited. The hospital has 52 beds with 2 units, BIRU North and BIRU Southwhich had 3wards. Facilities comprise of a purpose-built building with full therapy suite including a hydrotherapy pool and transitional accommodation. The hospital provides medical care for patients with moderate to severe cognitive and behavioural disability following acquired brain injury. Therefore, the assessment was focused on the patient pathway for people who required medical care and services for people with an acquired brain injury. The 2 assessment service groups have produced identical reports.
The previous assessment in August 2024 was a focussed responsive assessment to concerns shared with the CQC. This assessment was not rated and we identified 10 breaches of regulations relating to: person-centred care, consent, staff training, risk management, premises, equipment, processes, care and treatment, records and governance. The service was still failing to provide care and treatment in a safe way for service users.
At this assessment in August 2025, safe and well led, as well as the service overall have been rated as requires improvement. Effective, caring and responsive has been rated as good. This meant the evidence showed there were shortfalls in the standard of care for some aspect of the service.
We rated the service as Requires Improvement. The service had made improvements and was no longer in breach of some regulations. However, we found 3 breaches of the regulations in relation to safe care and treatment, good governance and staffing.
The environment was not always safe for people using the service. Staff did not always have competencies and regular supervision as an assurance for keeping people safe. Medicine management was not always optimised. Capacity and consent processes were not always consistently applied. Governance systems were not always effective in identifying or addressing areas for improvement.
We have requested an action plan from the provider outlining how they will address the breaches of regulations identified.
People’s experience
We spoke with 33 patients and 11 relatives during our onsite assessment and gained feedback from people collected by Healthwatch.
Some people could not tell us about their experience. We used a structured observation tool, Short Observational Framework for Inspection 2, to assess whether they received good care. This allowed usto capture the experiences of people who may not have been able to express this for themselves. This approached showed people were included with warmth and genuineness. Staff validated people and treated them with privacy and dignity. People were often empowered to engage with other people and their environment. However, we observed this was not always consistent, with one interaction showing members of staff discussing other patients’ circumstances with one another while caring for people.
People we spoke with were overwhelmingly positive about the caring nature of staff. One person said “Staff are glorious. Everyone is happy and positive.” People felt safe and mostly felt involved their care. People said staff treated them as individuals, respected their choices and were always happy to help. One person said, “some staff go above and beyond to help”. People told us staff always asked for their consent to help them. While the people we spoke with expressed they were happy with their care, our assessment found elements of the care did not always meet the expected standards. People said communication could be improved. People sometimes felt they would not be involved in planning their care if they did not ask questions. Relatives felt communication about care plans and incidents involving loved ones was not always consistent.
People said they sometimes had to wait for help. We observed varied lengths of time for staff to answer call bells. One call took 8 minutes for a response with the issue raised not addressed when the bell was switched off. However, other calls were responded to in less than a minute. One relative raised concerns about pressure injuries developing after admission. We found 5 out of 6 incidents reported in one month related to new pressure sores.
People said they did not receive enough therapy input. One person said, “my 8 week stay could have been met in 2-3 weeks”. Another person said they would like more varied activities and there was not enough input at weekends.
People and relatives were involved in service improvements with patient and relative forums. A multi-faith room had been created for people to use as a quiet space for reflection or prayer. However, it was external to the main building and people were mostly unaware of this facility. The room was difficult to access, and staff told us most people chose to stay in their own rooms if they wanted a space to pray. People told us the service had good food. People who had specific cultural or dietary requirements for food were catered for. We saw examples of people’s food preferences and dislikes being accommodated into their menu choices.
Feedback from people via Healthwatch was positive. People said staff were polite and professional. One person said the service had “improved my health and wellbeing”.